title: Contribution of technetium-99m hexamethylpropylene amine oxime labelled leucocyte scintigraphy to the diagnosis of diabetic foot infection.
abstract: We conducted a prospective study in order to evaluate the contribution of technetium-99m hexamethylpropylene amine oxime (HMPAO) labelled leucocyte scintigraphy to the diagnosis and follow-up of osteomyelitis in the diabetic foot. The study was conducted between October 1992 and November 1996 and included 42 patients (30 men and 12 women; mean age 63 years) with diabetes mellitus (type 1, n = 22, type 2, n = 20) who had a total of 56 diabetic foot ulcers. The initial exploration included standard radiography, three-phase bone scintigraphy and 99mTc-HMPAO labelled leucocyte scintigraphy (HMPAO-LS), performed within a 3-day interval. For the 56 ulceration sites, 26 cases of osteomyelitis were diagnosed: ten on the basis of radiographic and histological/bacteriological criteria after bone biopsy, 11 after radiographic follow-up and five on the basis of biopsy results alone. No osteomyelitis was present at 30 sites, there were seven cases of cellulitis. The sensitivity and specificity of 99mTc-HMPAO-LS were 88.4% and 96.6% respectively (23 true-positives, 29 true-negatives, one false-positive, three false-negatives). The accuracy of radiography, 99mTc-methylene diphosphonate and HMPAO-LS was 69.6%, 62.5%, and 92.9%, respectively. Follow-up scintigraphy (n = 14) 4 months after initial diagnosis and 1 month after antibiotic withdrawal confirmed cure of osteomyelitis despite the absence of complete clinical regression of the ulcers. In conclusion, 99mTc-HMPAO labelled leucocyte scintigraphy was found to be an excellent method for the diagnosis of osteomyelitis in the diabetic foot. It can contribute to follow-up, particularly when clinical regression of perforating ulcers is incomplete and cure of osteomyelitis must be confirmed in order that antibiotic treatment may be discontinued.
authors.affiliation: CRLCC Eugène Marquis, Service de médecine nucléaire, Rennes, France.
authors.forename: A
authors.initials: A
authors.lastname: Devillers
authors.forename: A
authors.initials: A
authors.lastname: Moisan
authors.forename: F
authors.initials: F
authors.lastname: Hennion
authors.forename: E
authors.initials: E
authors.lastname: Garin
authors.forename: J Y
authors.initials: JY
authors.lastname: Poirier
authors.forename: P
authors.initials: P
authors.lastname: Bourguet
mesh_terms: D000328:Adult; D000368:Aged; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging; D017719:Diabetic Foot / Q000097:blood / Q000000981:diagnostic imaging* / Q000209:etiology; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007962:Leukocytes; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000097:blood / Q000000981:diagnostic imaging* / Q000209:etiology; D011446:Prospective Studies; D011859:Radiography; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime
chemical_list: D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime